User interface with view finder for localizing anatomical region

ABSTRACT

An external control device for use with a medical component implanted within a patient. The device comprises a user interface configured for receiving user input, displaying a first graphical representation of the medical component in the context of a global graphical representation of an anatomical region of the patient, displaying a view finder defining a portion of the global graphical representation, and displaying a second graphical representation of the medical component in the context of a local graphical representation of the portion of the anatomical region portion. The external control device further comprises control circuitry configured for, in response to the input from the user, modifying the displayed view finder to spatially define a different portion of the global graphical representation, such that the second graphical representation of the medical component is displayed in the context of a local graphical representation of the different portion of the anatomical region.

RELATED APPLICATION DATA

The present application is a continuation of U.S. application Ser. No.16/237,505, filed Dec. 31, 2018, which is a continuation of U.S.application Ser. No. 15/254,422, filed Sep. 1, 2016, now issued as U.S.Pat. No. 10,213,607, which is a continuation of U.S. application Ser.No. 13/445,179, filed Apr. 12, 2012, now issued as U.S. Pat. No.9,433,795, which claims the benefit under 35 U.S.C. § 119 to U.S.provisional patent application Ser. No. 61/474,884, filed Apr. 13, 2011.The foregoing applications are hereby incorporated by reference into thepresent application in their entirety.

FIELD OF THE INVENTION

The present invention relates to medical systems, and more particularly,to a user interface for displaying anatomical regions of patients.

BACKGROUND OF THE INVENTION

Implantable neurostimulation systems have proven therapeutic in a widevariety of diseases and disorders. Pacemakers and Implantable CardiacDefibrillators (ICDs) have proven highly effective in the treatment of anumber of cardiac conditions (e.g., arrhythmias). Spinal CordStimulation (SCS) systems have long been accepted as a therapeuticmodality for the treatment of chronic pain syndromes, and theapplication of tissue stimulation has begun to expand to additionalapplications such as angina pectoralis and incontinence. Deep BrainStimulation (DBS) has also been applied therapeutically for well over adecade for the treatment of refractory chronic pain syndromes, and DBShas also recently been applied in additional areas such as movementdisorders and epilepsy. Further, in recent investigations PeripheralNerve Stimulation (PNS) systems have demonstrated efficacy in thetreatment of chronic pain syndromes and incontinence, and a number ofadditional applications are currently under investigation. Also,Functional Electrical Stimulation (FES) systems such as the Freehandsystem by NeuroControl (Cleveland, Ohio) have been applied to restoresome functionality to paralyzed extremities in spinal cord injurypatients.

These implantable neurostimulation systems typically include one or moreelectrode carrying neurostimulation leads, which are implanted at thedesired stimulation site, and a neurostimulator (e.g., an implantablepulse generator (IPG)) implanted remotely from the stimulation site, butcoupled either directly to the neurostimulation lead(s) or indirectly tothe neurostimulation lead(s) via a lead extension. Thus, electricalpulses can be delivered from the neurostimulator to the neurostimulationleads to stimulate the tissue and provide the desired efficacioustherapy to the patient. The neurostimulation system may further comprisea handheld patient programmer in the form of a remote control (RC) toremotely instruct the neurostimulator to generate electrical stimulationpulses in accordance with selected stimulation parameters. The RC may,itself, be programmed by a clinician, for example, by using aclinician's programmer (CP), which typically includes a general purposecomputer, such as a laptop, with a programming software packageinstalled thereon.

In the context of an SCS procedure, one or more neurostimulation leadsare introduced through the patient's back into the epidural space, suchthat the electrodes carried by the leads are arranged in a desiredpattern and spacing to create an electrode array. Multi-leadconfigurations have been increasingly used in electrical stimulationapplications (e.g., neurostimulation, cardiac resynchronization therapy,etc.). In the neurostimulation application of SCS, the use of multipleleads increases the stimulation area and penetration depth (thereforecoverage), as well as enables more combinations of anodic and cathodicelectrodes for stimulation, such as transverse multipolar (bipolar,tripolar, or quadra-polar) stimulation, in addition to any longitudinalsingle lead configuration. After proper placement of theneurostimulation leads at the target area of the spinal cord, the leadsare anchored in place at an exit site to prevent movement of theneurostimulation leads. To facilitate the location of theneurostimulator away from the exit point of the neurostimulation leads,lead extensions are sometimes used.

The neurostimulation leads, or the lead extensions, are then connectedto the IPG, which can then be operated to generate electrical pulsesthat are delivered, through the electrodes, to the targeted tissue, andin particular, the dorsal column and dorsal root fibers within thespinal cord. The stimulation creates the sensation known as paresthesia,which can be characterized as an alternative sensation that replaces thepain signals sensed by the patient.

The efficacy of SCS is related to the ability to stimulate the spinalcord tissue corresponding to evoked paresthesia in the region of thebody where the patient experiences pain. Thus, the working clinicalparadigm is that achievement of an effective result from SCS depends onthe neurostimulation lead or leads being placed in a location (bothlongitudinal and lateral) relative to the spinal tissue such that theelectrical stimulation will induce paresthesia located in approximatelythe same place in the patient's body as the pain (i.e., the target oftreatment). If a lead is not correctly positioned, it is possible thatthe patient will receive little or no benefit from an implanted SCSsystem. Thus, correct lead placement can mean the difference betweeneffective and ineffective pain therapy.

As such, the CP (described briefly above) may be used to instruct theneurostimulator to apply electrical stimulation to test placement of theleads and/or electrodes inter-operatively (i.e., in the context of anoperating room (OR) mapping procedure), thereby assuring that the leadsand/or electrodes are implanted in effective locations within thepatient. The patient may provide verbal feedback regarding the presenceof paresthesia over the pain area, and based on this feedback, the leadpositions may be adjusted and re-anchored if necessary. Any incisionsare then closed to fully implant the system.

Post-operatively (i.e., after the surgical procedure has beencompleted), a fitting procedure, which may be referred to as anavigation session, may be performed using the CP to program the RC, andif applicable the IPG, with a set of stimulation parameters that bestaddresses the painful site, thereby optimizing or re-optimizing thetherapy. Thus, the navigation session may be used to pinpoint thestimulation region or areas correlating to the pain. Such programmingability is particularly advantageous after implantation should the leadsgradually or unexpectedly move, which if uncorrected, would relocate theparesthesia away from the pain site.

Typical programmable neurostimulation systems require a means to locateand navigate to a targeted implant location. For example, in the contextof SCS, the CP may display graphical representations of theneurostimulation leads in relation to the spinal column of the patient,as described in U.S. Provisional Patent Application Ser. No. 61/390,112,entitled Neurostimulation System and Method with Anatomy and PhysiologyDriven Programming,” which is expressly incorporated herein byreference. Because it is desirable that the entire work area for animplant be displayed to medical personnel, current neurostimulationsystems should display the entire spinal column, since neurostimulationleads can be implanted anywhere within the spinal column. However,because the size of a neurostimulation lead is much smaller than that ofthe spinal column, standard user interfaces are limited in thatdisplaying the neurostimulation leads in the context of the entirespinal column may render any details of the neurostimulation leads andthe immediately relevant region of the spinal column illegible.

There, thus, remains a need to provide a user interface capable ofdisplaying an implant in the context of the entire work area while alsodisplaying any details of the implant and the immediately surroundingportion of the work area in a legible manner.

SUMMARY OF THE INVENTION

In accordance with the present inventions, an external control devicefor use with a medical component (e.g., a neurostimulation lead)implanted within a patient is provided. The external control devicecomprises a user interface configured for receiving input from a user,displaying a first graphical representation of the medical component inthe context of a global view of an anatomical region (e.g., a spinalcolumn) of the patient, displaying a view finder (e.g., a box) spatiallydefining a portion of the global graphical representation of theanatomical region, and displaying a second graphical representation ofthe medical component in the context of a local graphical representationof the portion of the anatomical region portion spatially defined by theview finder.

The external control device further comprises control circuitryconfigured for, in response to the input from the user, modifyingdisplayed view finder to spatially define a different portion of theglobal graphical representation of the anatomical region, such that thesecond graphical representation of the medical component is displayed inthe context of a local graphical representation of the different portionof the anatomical region. The control circuitry may be configured for,in response to the input from the user, modifying the displayed viewfinder by changing a position of the displayed view finder relative tothe global graphical representation. In one embodiment, the controlcircuitry is configured for, in response to the input from the user,limiting the change in the position of the displayed view finder in onedimension. In another embodiment, the control circuitry is configuredfor, in response to the input from the user, changing the position ofthe displayed view finder in two dimensions. The control circuitry mayalternatively or additionally be configured for, in response to theinput from the user, modifying the displayed view finder by changing asize of the displayed view finder.

In one embodiment, the user interface comprises a control elementconfigured for being manipulated by the user, and the control circuitryis configured for modifying the displayed view finder to spatiallydefine the different portion of the global graphical representation ofthe anatomical region in response to the user manipulation of thecontrol element, e.g., a graphical control element. The graphicalcontrol element may be disposed on the view finder. Or, the graphicalcontrol element may be separate from the view finder. For example, thegraphical control element may comprise a graphical slider bar. The userinput may comprise manipulating a pointing device, in which case, thegraphical control element may be configured for being manipulated viathe pointing device.

In an optional embodiment, the control circuitry is further configuredfor, in response to additional input from the user, defining a locationof the graphical representation of the medical device relative to atleast one of the global graphical representation of the anatomicalregion and the local graphical representation of the portion of theanatomical region. In another optional embodiment, the control circuitryis further configured for, in response to additional input from theuser, programming the medical component.

Other and further aspects and features of the invention will be evidentfrom reading the following detailed description of the preferredembodiments, which are intended to illustrate, not limit, the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate the design and utility of preferred embodimentsof the present invention, in which similar elements are referred to bycommon reference numerals. In order to better appreciate how theabove-recited and other advantages and objects of the present inventionsare obtained, a more particular description of the present inventionsbriefly described above will be rendered by reference to specificembodiments thereof, which are illustrated in the accompanying drawings.Understanding that these drawings depict only typical embodiments of theinvention and are not therefore to be considered limiting of its scope,the invention will be described and explained with additionalspecificity and detail through the use of the accompanying drawings inwhich:

FIG. 1 is perspective view of one embodiment of a SCS system arranged inaccordance with the present inventions;

FIG. 2 is a plan view of the SCS system of FIG. 1 in use with a patient;

FIG. 3 is a side view of an implantable pulse generator and a pair ofstimulation leads that can be used in the SCS system of FIG. 1;

FIG. 4 is a plan view of a remote control that can be used in the SCSsystem of FIG. 1;

FIG. 5 is a block diagram of the internal componentry of the remotecontrol of FIG. 4;

FIG. 6 is a block diagram of the components of a clinician programmerthat can be used in the SCS system of FIG. 1;

FIG. 7 is an illustration of a lead configuration screen that can bedisplayed by the clinician programmer of FIG. 6, wherein a graphicallead configuration is displayed over a composite graphicalrepresentation of a spinal column;

FIG. 8 is an illustration of the lead configuration screen of FIG. 7,wherein a view finder is displaced along the spinal column;

FIG. 9 is an illustration of the lead configuration screen of FIG. 7,wherein the view finder is expanded; and

FIG. 10 is an illustration of the lead configuration screen of FIG. 7,wherein the view finder is contracted.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The description that follows relates to a spinal cord stimulation (SCS)system. However, it is to be understood that the while the inventionlends itself well to applications in SCS, the invention, in its broadestaspects, may not be so limited. Rather, the invention may be used withany type of implantable electrical circuitry used to stimulate tissue.For example, the present invention may be used as part of a pacemaker, adefibrillator, a cochlear stimulator, a retinal stimulator, a stimulatorconfigured to produce coordinated limb movement, a cortical stimulator,a deep brain stimulator, peripheral nerve stimulator, microstimulator,or in any other neural stimulator configured to treat urinaryincontinence, sleep apnea, shoulder sublaxation, headache, etc.

Turning first to FIG. 1, an exemplary SCS system 10 generally includes aplurality (in this case, two) of implantable neurostimulation leads 12,an implantable pulse generator (IPG) 14, an external remote controllerRC 16, a clinician's programmer (CP) 18, an external trial stimulator(ETS) 20, and an external charger 22.

The IPG 14 is physically connected via one or more percutaneous leadextensions 24 to the neurostimulation leads 12, which carry a pluralityof electrodes 26 arranged in an array. In the illustrated embodiment,the neurostimulation leads 12 are percutaneous leads, and to this end,the electrodes 26 are arranged in-line along the neurostimulation leads12. The number of neurostimulation leads 12 illustrated is two, althoughany suitable number of neurostimulation leads 12 can be provided,including only one. Alternatively, a surgical paddle lead in can be usedin place of one or more of the percutaneous leads. As will be describedin further detail below, the IPG 14 includes pulse generation circuitrythat delivers electrical stimulation energy in the form of a pulsedelectrical waveform (i.e., a temporal series of electrical pulses) tothe electrode array 26 in accordance with a set of stimulationparameters.

The ETS 20 may also be physically connected via the percutaneous leadextensions 28 and external cable 30 to the neurostimulation leads 12.The ETS 20, which has similar pulse generation circuitry as the IPG 14,also delivers electrical stimulation energy in the form of a pulseelectrical waveform to the electrode array 26 accordance with a set ofstimulation parameters. The major difference between the ETS 20 and theIPG 14 is that the ETS 20 is a non-implantable device that is used on atrial basis after the neurostimulation leads 12 have been implanted andprior to implantation of the IPG 14, to test the responsiveness of thestimulation that is to be provided. Thus, any functions described hereinwith respect to the IPG 14 can likewise be performed with respect to theETS 20. Further details of an exemplary ETS are described in U.S. Pat.No. 6,895,280, which is expressly incorporated herein by reference.

The RC 16 may be used to telemetrically control the ETS 20 via abi-directional RF communications link 32. Once the IPG 14 andneurostimulation leads 12 are implanted, the RC 16 may be used totelemetrically control the IPG 14 via a bi-directional RF communicationslink 34. Such control allows the IPG 14 to be turned on or off and to beprogrammed with different stimulation parameter sets. The IPG 14 mayalso be operated to modify the programmed stimulation parameters toactively control the characteristics of the electrical stimulationenergy output by the IPG 14. As will be described in further detailbelow, the CP 18 provides clinician detailed stimulation parameters forprogramming the IPG 14 and ETS 20 in the operating room and in follow-upsessions.

The CP 18 may perform this function by indirectly communicating with theIPG 14 or ETS 20, through the RC 16, via an IR communications link 36.Alternatively, the CP 18 may directly communicate with the IPG 14 or ETS20 via an RF communications link (not shown). The clinician detailedstimulation parameters provided by the CP 18 are also used to programthe RC 16, so that the stimulation parameters can be subsequentlymodified by operation of the RC 16 in a stand-alone mode (i.e., withoutthe assistance of the CP 18).

The external charger 22 is a portable device used to transcutaneouslycharge the IPG 14 via an inductive link 38. For purposes of brevity, thedetails of the external charger 22 will not be described herein. Detailsof exemplary embodiments of external chargers are disclosed in U.S. Pat.No. 6,895,280, which has been previously incorporated herein byreference. Once the IPG 14 has been programmed, and its power source hasbeen charged by the external charger 22 or otherwise replenished, theIPG 14 may function as programmed without the RC 16 or CP 18 beingpresent.

As shown in FIG. 2, the neurostimulation leads 12 are implanted withinthe spinal column 42 of a patient 40. The preferred placement of theneurostimulation leads 12 is adjacent, i.e., resting upon, the spinalcord area to be stimulated. Due to the lack of space near the locationwhere the neurostimulation leads 12 exit the spinal column 42, the IPG14 is generally implanted in a surgically-made pocket either in theabdomen or above the buttocks. The IPG 14 may, of course, also beimplanted in other locations of the patient's body. The lead extension24 facilitates locating the IPG 14 away from the exit point of theneurostimulation leads 12. As there shown, the CP 18 communicates withthe IPG 14 via the RC 16.

Referring now to FIG. 3, the external features of the neurostimulationleads 12 and the IPG 14 will be briefly described. One of theneurostimulation leads 12 a has eight electrodes 26 (labeled E1-E8), andthe other stimulation lead 12 b has eight electrodes 26 (labeledE9-E16). The actual number and shape of leads and electrodes will, ofcourse, vary according to the intended application. The IPG 14 comprisesan outer case 40 for housing the electronic and other components(described in further detail below), and a connector 42 to which theproximal ends of the neurostimulation leads 12 mates in a manner thatelectrically couples the electrodes 26 to the electronics within theouter case 40. The outer case 40 is composed of an electricallyconductive, biocompatible material, such as titanium, and forms ahermetically sealed compartment wherein the internal electronics areprotected from the body tissue and fluids. In some cases, the outer case40 may serve as an electrode.

The IPG 14 includes a battery and pulse generation circuitry thatdelivers the electrical stimulation energy in the form of a pulsedelectrical waveform to the electrode array 26 in accordance with a setof stimulation parameters programmed into the IPG 14. Such stimulationparameters may comprise electrode combinations, which define theelectrodes that are activated as anodes (positive), cathodes (negative),and turned off (zero), percentage of stimulation energy assigned to eachelectrode (fractionalized electrode configurations), and electricalpulse parameters, which define the pulse amplitude (measured inmilliamps or volts depending on whether the IPG 14 supplies constantcurrent or constant voltage to the electrode array 26), pulse width(measured in microseconds), and pulse rate (measured in pulses persecond).

Electrical stimulation will occur between two (or more) activatedelectrodes, one of which may be the IPG case. Simulation energy may betransmitted to the tissue in a monopolar or multipolar (e.g., bipolar,tripolar, etc.) fashion. Monopolar stimulation occurs when a selectedone of the lead electrodes 26 is activated along with the case of theIPG 14, so that stimulation energy is transmitted between the selectedelectrode 26 and case. Bipolar stimulation occurs when two of the leadelectrodes 26 are activated as anode and cathode, so that stimulationenergy is transmitted between the selected electrodes 26. For example,electrode E3 on the first lead 12 may be activated as an anode at thesame time that electrode E11 on the second lead 12 is activated as acathode. Tripolar stimulation occurs when three of the lead electrodes26 are activated, two as anodes and the remaining one as a cathode, ortwo as cathodes and the remaining one as an anode. For example,electrodes E4 and E5 on the first lead 12 may be activated as anodes atthe same time that electrode E12 on the second lead 12 is activated as acathode.

In the illustrated embodiment, IPG 14 can individually control themagnitude of electrical current flowing through each of the electrodes.In this case, it is preferred to have a current generator, whereinindividual current-regulated amplitudes from independent current sourcesfor each electrode may be selectively generated. Although this system isoptimal to take advantage of the invention, other stimulators that maybe used with the invention include stimulators having voltage regulatedoutputs. While individually programmable electrode amplitudes areoptimal to achieve fine control, a single output source switched acrosselectrodes may also be used, although with less fine control inprogramming. Mixed current and voltage regulated devices may also beused with the invention. Further details discussing the detailedstructure and function of IPGs are described more fully in U.S. Pat.Nos. 6,516,227 and 6,993,384, which are expressly incorporated herein byreference.

It should be noted that rather than an IPG, the SCS system 10 mayalternatively utilize an implantable receiver-stimulator (not shown)connected to the neurostimulation leads 12. In this case, the powersource, e.g., a battery, for powering the implanted receiver, as well ascontrol circuitry to command the receiver-stimulator, will be containedin an external controller inductively coupled to the receiver-stimulatorvia an electromagnetic link. Data/power signals are transcutaneouslycoupled from a cable-connected transmission coil placed over theimplanted receiver-stimulator. The implanted receiver-stimulatorreceives the signal and generates the stimulation in accordance with thecontrol signals.

Referring now to FIG. 4, one exemplary embodiment of an RC 16 will nowbe described. As previously discussed, the RC 16 is capable ofcommunicating with the IPG 14, CP 18, or ETS 20. The RC 16 comprises acasing 50, which houses internal componentry (including a printedcircuit board (PCB)), and a lighted display screen 52 and button pad 54carried by the exterior of the casing 50. In the illustrated embodiment,the display screen 52 is a lighted flat panel display screen, and thebutton pad 54 comprises a membrane switch with metal domes positionedover a flex circuit, and a keypad connector connected directly to a PCB.In an optional embodiment, the display screen 52 has touchscreencapabilities. The button pad 54 includes a multitude of buttons 56, 58,60, and 62, which allow the IPG 14 to be turned ON and OFF, provide forthe adjustment or setting of stimulation parameters within the IPG 14,and provide for selection between screens.

In the illustrated embodiment, the button 56 serves as an ON/OFF buttonthat can be actuated to turn the IPG 14 ON and OFF. The button 58 servesas a select button that allows the RC 16 to switch between screendisplays and/or parameters. The buttons 60 and 62 serve as up/downbuttons that can be actuated to increment or decrement any ofstimulation parameters of the pulse generated by the IPG 14, includingpulse amplitude, pulse width, and pulse rate. For example, the selectionbutton 58 can be actuated to place the RC 16 in a “Pulse AmplitudeAdjustment Mode,” during which the pulse amplitude can be adjusted viathe up/down buttons 60, 62, a “Pulse Width Adjustment Mode,” duringwhich the pulse width can be adjusted via the up/down buttons 60, 62,and a “Pulse Rate Adjustment Mode,” during which the pulse rate can beadjusted via the up/down buttons 60, 62. Alternatively, dedicatedup/down buttons can be provided for each stimulation parameter. Ratherthan using up/down buttons, any other type of actuator, such as a dial,slider bar, or keypad, can be used to increment or decrement thestimulation parameters. Further details of the functionality andinternal componentry of the RC 16 are disclosed in U.S. Pat. No.6,895,280, which has previously been incorporated herein by reference.

Referring to FIG. 5, the internal components of an exemplary RC 16 willnow be described. The RC 16 generally includes a processor 64 (e.g., amicrocontroller), memory 66 that stores an operating program forexecution by the processor 64, as well as stimulation parameter sets ina navigation table (described below), input/output circuitry, and inparticular, telemetry circuitry 68 for outputting stimulation parametersto the IPG 14 and receiving status information from the IPG 14, andinput/output circuitry 70 for receiving stimulation control signals fromthe button pad 54 and transmitting status information to the displayscreen 52 (shown in FIG. 4). As well as controlling other functions ofthe RC 16, which will not be described herein for purposes of brevity,the processor 64 generates new stimulation parameter sets in response tothe user operation of the button pad 54. These new stimulation parametersets would then be transmitted to the IPG 14 via the telemetry circuitry68. Further details of the functionality and internal componentry of theRC 16 are disclosed in U.S. Pat. No. 6,895,280, which has previouslybeen incorporated herein by reference.

As briefly discussed above, the CP 18 greatly simplifies the programmingof multiple electrode combinations, allowing the user (e.g., thephysician or clinician) to readily determine the desired stimulationparameters to be programmed into the IPG 14, as well as the RC 16. Thus,modification of the stimulation parameters in the programmable memory ofthe IPG 14 after implantation is performed by a user using the CP 18,which can directly communicate with the IPG 14 or indirectly communicatewith the IPG 14 via the RC 16. That is, the CP 18 can be used by theuser to modify operating parameters of the electrode array 26 near thespinal cord.

As shown in FIG. 2, the overall appearance of the CP 18 is that of alaptop personal computer (PC), and in fact, may be implemented using aPC that has been appropriately configured to include adirectional-programming device and programmed to perform the functionsdescribed herein. Alternatively, the CP 18 may take the form of amini-computer, personal digital assistant (PDA), etc., or even a remotecontrol (RC) with expanded functionality. Thus, the programmingmethodologies can be performed by executing software instructionscontained within the CP 18. Alternatively, such programmingmethodologies can be performed using firmware or hardware. In any event,the CP 18 may actively control the characteristics of the electricalstimulation generated by the IPG 14 to allow the optimum stimulationparameters to be determined based on patient feedback and forsubsequently programming the IPG 14 with the optimum stimulationparameters.

To allow the user to perform these functions, the CP 18 includes a mouse72, a keyboard 74, and a programming display screen 76 housed in a case78. It is to be understood that in addition to, or in lieu of, the mouse72, other directional programming devices may be used, such as atrackball, touchpad, joystick, or directional keys included as part ofthe keys associated with the keyboard 74.

In the illustrated embodiment described below, the display screen 76takes the form of a conventional screen, in which case, a virtualpointing device, such as a cursor controlled by a mouse, joy stick,trackball, etc, can be used to manipulate graphical objects on thedisplay screen 76. In alternative embodiments, the display screen 76takes the form of a digitizer touch screen, which may either passive oractive. If passive, the display screen 76 includes detection circuitrythat recognizes pressure or a change in an electrical current when apassive device, such as a finger or non-electronic stylus, contacts thescreen. If active, the display screen 76 includes detection circuitrythat recognizes a signal transmitted by an electronic pen or stylus. Ineither case, detection circuitry is capable of detecting when a physicalpointing device (e.g., a finger, a non-electronic stylus, or anelectronic stylus) is in close proximity to the screen, whether it bemaking physical contact between the pointing device and the screen orbringing the pointing device in proximity to the screen within apredetermined distance, as well as detecting the location of the screenin which the physical pointing device is in close proximity. When thepointing device touches or otherwise is in close proximity to thescreen, the graphical object on the screen adjacent to the touch pointis “locked” for manipulation, and when the pointing device is moved awayfrom the screen the previously locked object is unlocked.

As shown in FIG. 6, the CP 18 generally includes control circuitry 80(e.g., a central processor unit (CPU)) and memory 82 that stores astimulation programming package 84, which can be executed by the controlcircuitry 80 to allow the user to program the IPG 14, and RC 16. The CP18 further includes output circuitry 86 (e.g., via the telemetrycircuitry of the RC 16) for downloading stimulation parameters to theIPG 14 and RC 16 and for uploading stimulation parameters already storedin the memory 66 of the RC 16, via the telemetry circuitry 68 of the RC16.

Execution of the programming package 84 by the control circuitry 80provides a multitude of display screens (not shown) that can benavigated through via use of the mouse 72. These display screens allowthe clinician to, among other functions, to select or enter patientprofile information (e.g., name, birth date, patient identification,physician, diagnosis, and address), enter procedure information (e.g.,programming/follow-up, implant trial system, implant IPG, implant IPGand lead(s), replace IPG, replace IPG and leads, replace or reviseleads, explant, etc.), generate a pain map of the patient, define theconfiguration and orientation of the leads, initiate and control theelectrical stimulation energy output by the neurostimulation leads 12,and select and program the IPG 14 with stimulation parameters in both asurgical setting and a clinical setting. Further details discussing theabove-described CP functions are disclosed in U.S. patent applicationSer. No. 12/501,282, entitled “System and Method for Converting TissueStimulation Programs in a Format Usable by an Electrical CurrentSteering Navigator,” and U.S. patent application Ser. No. 12/614,942,entitled “System and Method for Determining Appropriate Steering Tablesfor Distributing Stimulation Energy Among Multiple NeurostimulationElectrodes,” which are expressly incorporated herein by reference.

Most pertinent to the present inventions, programming of the IPG 14 canbe performed based on a user-defined lead configuration corresponding tothe actual configuration in which the neurostimulation leads 12 arephysically implanted within the patient. This lead configuration isgraphically displayed in the context of an anatomical region, and inthis case, the spinal column of the patient. Preferably, the leadconfiguration is defined by the user to correspond with the actualconfiguration of the neurostimulation leads 12 within the patient, whichcan be obtained using suitable means, such as viewing a fluoroscopicimage of the neurostimulation leads 12 and surrounding tissue of thepatient, or using electrical means, such as transmitting electricalsignals between the electrodes carried by the respective leads andmeasuring electrical parameters in response to the electrical signals,such as, e.g., any one or more of the manners disclosed in U.S. Pat. No.6,993,384, entitled “Apparatus and Method for Determining the RelativePosition and Orientation of Neurostimulation Leads,” U.S. patentapplication Ser. No. 12/550,136, entitled “Method and Apparatus forDetermining Relative Positioning Between Neurostimulation Leads,” andU.S. patent application Ser. No. 12/623,976, entitled “Method andApparatus for Determining Relative Positioning Between NeurostimulationLeads,” which are expressly incorporated herein by reference.

Significantly, graphical representations of the neurostimulation leads12 are displayed in the context of a composite graphical representationof the spinal column of the patient, comprising a global graphicalrepresentation of the spinal column and a local graphical representationof a portion of the spinal column. A view finder is displayed over aportion of the global graphical spinal column representation, such thatthe portion of the local graphical spinal column representationcorresponds to the portion of the global graphical spinal columnrepresentation over which the view finder is displayed. The displayedview finder may be modified (e.g., by changing a position and/or size)to define a different portion of the global graphical spinal columnrepresentation, and the local graphical spinal column representationautomatically updated to reflect the portion of the global graphicalspinal column representation currently defined by the view finder. Inthis manner, the entirety of the spinal column work area may be quicklyestablished and easily navigated using the global graphicalrepresentation, while allowing instant assessment of the location andprogramming status of the neurostimulation leads 12 using the localgraphical representation.

As one example, and with reference to FIG. 7, a lead configurationscreen 100 illustrating a graphical representation of an adjustable leadconfiguration (in this case, consisting of three graphical leadrepresentations 12′) can be manipulated by the user to define the leadconfiguration that best matches the actual configuration of theneurostimulation leads 12. In the illustrated embodiment, the leadconfiguration screen 100 is segmented into a lead type selection section100 a displaying a plurality of lead generation icons 102 a-102 d, aglobal view section 100 b displaying a global graphical representationof the spinal column 42′, and a local view section 100 c displaying alocal graphical representation of the spinal column 42′.

In this embodiment, the graphical lead representations 12′ are displayedin a staggered arrangement that presumably matches the side-by-sidearrangement of the actual leads 12 implanted in the patient. Thegraphical lead representations 12′ are illustrated as being superimposedover a composite graphical representation of spinal column 42 atlocations matching the location of the spinal column 42 at which theactual leads 12 are implanted. The composite graphical representation ofthe spinal column 42 consists of the global graphical spinal columnrepresentation 42′ and the local graphical spinal column representation42″.

In order to define the lead configuration, objects can be dragged anddropped from a selected one of a plurality of lead generation icons 102a-d to generate the graphical lead representations 12′. As example, thelead generation icons include 1×8 percutaneous lead generation icon 102a, a 1×16 percutaneous lead 102 b, a 2×8 paddle lead 102 c, and a 4×8paddle lead 102 d. The location of the graphical lead representations 12relative to the global and local graphical spinal columns 42′, 42″, aswell as the longitudinal distance and/or lateral distance between thegraphical lead representations 12′, can be defined in this manner. Inthe illustrated embodiment, objects are dragged and dropped from the 1×8percutaneous lead generation icon 104 a to create a lead configurationconsisting of three virtual 1×8 percutaneous leads 12 a′, 12 b, 12 c′.The control circuitry 80 of the CP 18 allows the user to graphicallycreate new lead configurations from the initial lead configuration byallowing the user to select one of the graphical lead representations12′ (e.g., by coupling to one of the graphical lead representations12′), dragging the selected graphical lead representation 12′ (e.g., bydisplacing the selected graphical lead representation 12′ relative tothe other graphical lead representation 12′), and dropping the displacedgraphical lead representation 12′ (e.g., by decoupling from thedisplaced graphical lead representation 12′). The object can either bedropped into the global view section 100 b to define a graphical leadrepresentation 12 relative to the global graphical spinal column 42′ (inwhich case, the local view section 100 c will be automatically updatedwith the graphical lead representation 12′) or dropped into the localview section 100 c to define a graphical lead representation 12 relativeto the local graphical spinal column representation 42″ (in which case,the global view section 100 b will be automatically updated with thegraphical lead representation 12′).

The manner in which a graphical lead representation 12′ is selected,dragged, and dropped will depend on the nature of the user interface.For example, if the display screen 76 is conventional, a virtualpointing device (e.g., cursor controlled by the mouse 72, joy stick,trackball, etc.) can be used to select, drag, and drop the graphicallead representations 12′ into the global or local view sections 100 b,100 c. If the display screen 76 is a digitizer screen, a physicalpointing device (e.g., a stylus or finger) can be used to select, drag,and drop the graphical lead representations 12′ into the global or localview sections 100 b, 100 c. Further details discussing the generation oflead configurations using a drag and drop technique are set forth inU.S. Provisional Patent Application Ser. No. 61/333,673, entitled“System and Method for Defining Neurostimulation Lead Configurations,”which is expressly incorporated herein by reference.

As briefly discussed above, a view finder 104 is displayed over aportion of the global graphical spinal column representation 42′. In theillustrated embodiment, the view finder 104 takes the form of a boxoutline. Alternatively, the view finder 104 may take the form of othershapes, such as a circle outline. In the case illustrated in FIG. 7, theportion of the global graphical spinal column representation 42′ overwhich the view finder 104 is displayed consists of the T7-T10 vertebralsegments, and thus, the displayed local graphical spinal columnrepresentation 42″ consists of the T7-T10 vertebral segments (includingthe entire graphical lead representations 12 b and 12 c).

The displayed view finder 104 may be displaced (and in this case,scrolled longitudinally along the global graphical spinal columnrepresentation 42′) to another different portion of the global graphicalspinal column representation 42′, such that at least one of thegraphical lead representations 12′ is displayed in the local graphicalrepresentation of the other portion of the spinal column 42″. Thus, asthe view finder 104 is scrolled along the global graphical spinal columnrepresentation 42′, the local graphical spinal column representation 42″will automatically update to reflect the portion of the global graphicalspinal column representation 42″ spatially defined by the view finder104.

For example, as illustrated in FIG. 8, the different portion of theglobal graphical spinal column representation 42′ over which the viewfinder 104 is displayed consists of the T1-T5 vertebral segments(including graphical lead representation 12 a). In the illustratedembodiment, displacement of the view finder 104 is limited to one axisalong the spinal column. In an optional embodiment, the view finder 104may be displaced in the lateral direction (left and right), in additionto the longitudinal direction (up and down), thereby allowing the viewfinder 104 to be displaced in two dimensions.

The lead configuration screen 100 includes different control elementsfor displacing the view finder 104. For example, the view finder 104may, itself, serve as a graphical control element. If the display screen76 is conventional, the user may click on the view finder 104 using avirtual pointing device in the form of a graphical cursor 106 (shown asa hand) via a mouse 72 or other pointing device, and drag the viewfinder 104 to a different portion of the global graphical spinal columnrepresentation 42″. If the display screen 76 is a digitizer screen, theuser may place a physical pointing device adjacent the view finder 104and draft the view finder 104 to a different portion of the globalgraphical spinal column representation 42″. In the illustratedembodiment, the outline of the view finder 104 or any graphical spacecontained in the outline may be manipulated by the pointing device todisplace the view finder 104.

Alternatively, the graphical control element may be completely separatefrom the view finder 104. For example, the graphical control element cantake the form of a graphical slider bar 108, which in the exemplary leadconfiguration screen 100, is adjacent the local graphical spinal columnrepresentation 42′. The graphical slider bar 108 can be moved up or downusing, e.g., a pointing device (not shown), to thereby scroll the viewfinder 104 longitudinally along the global graphical spinal columnrepresentation 42″. As the view finder 104 is scrolled along the globalgraphical spinal column representation 42″, the local graphical spinalcolumn representation 42″ will automatically update to reflect theportion of the global graphical spinal column representation 42″ withinthe view finder 104.

In other embodiments, the control element may be simply be distributedon the local graphical spinal column representation 42′ and surroundingarea on the display screen 100. That is, any area in the local viewsection 100 c can be manipulated (e.g., clicked or touched) using, e.g.,a pointing device (not shown), to thereby scroll the view finder 104longitudinally along the global graphical spinal column representation42″. Again, as the view finder 104 is scrolled along the globalgraphical spinal column representation 42″, the local graphical spinalcolumn representation 42″ will automatically update to reflect theportion of the global graphical spinal column representation 42″ withinthe view finder 104.

In an optional embodiment, the individual vertebral segments (or thevertebral segment labels) of the global graphical spinal columnrepresentation 42″ the individual lead representations 12′ displayed onthe global view section 100 b may serve as graphical control elements.For example, any of the vertebral segments or lead representations canbe clicked or otherwise touched, such that the view finder 104 isautomatically centered on the vertebral segment or lead representationthat is clicked or touched. For example, if any portion of the vertebralsegment T7 is clicked or touched, the view finder 104 may beautomatically centered on the vertebral segment T7, such that the centerof the vertebral segment T7 coincides with the center of the view finder104 in the global view section 100 b, and therefore, is centered in thelocal view section 100 c. Similarly, if any portion of the graphicallead representation 12 b is clicked or touched, the view finder 104 maybe automatically centered on the graphical lead representation 12 b,such that the center of the graphical lead representation 12 b coincideswith the center of the view finder 104 in the global view section 100 b,and therefore, is centered in the local view section 100 c. In stillanother optional embodiment, if the control element may be distributedon the graphical view section 100 b, such that any point that is clickedor touched on the graphical view section 100 b will prompt the viewfinder 104 to be centered on that point.

In addition to being displaced, the size of the displayed view finder104 may optionally be changed; for example, expanded or contracted, suchthat the size of the local graphical spinal column representation 42″ iscorrespondingly changed. The lead configuration screen 100 may includedifferent control elements for displacing the view finder 104. Forexample, as shown in FIGS. 9 and 10, control elements may take the formof upper and lower handles 110 a, 110 b respectively extending from thetop and bottom borders of the view finder 104. Either of the handles 110can be dragged using a pointing device (not shown) to expand or contactthe view finder 104 in the upward or downward direction. For example,the upper handle 110 a may be dragged upward to correspondingly expandthe view finder 104 in the upward direction, as shown in FIG. 9, or theupper handle 110 a may be dragged downward to correspondingly contractthe view finder 104 in the downward direction, as shown in FIG. 10. Itcan be appreciated that the lower handle 110 b may be also draggeddownward to correspondingly expand the view finder 104 in the downwarddirection, or the lower handle 110 b may also be dragged upward tocorresponding contract the view finder 104 in the upward direction.Optionally, left and right handles (not shown) can respectively extendfrom the left and right borders of the view finder 104. In this case,these handles may be dragged leftward or rightward to expand or contractthe view finder 104 in the left or right directions.

As the view finder 100 is expanded or contracted, the local graphicalspinal column representation 42″ will automatically update to reflectthe expanded or contracted portion of the global graphical spinal columnrepresentation 42″ within the view finder 104. In the case illustratedin FIG. 9, the portion of the global graphical spinal columnrepresentation 42′ over which the view finder 104 is displayed isexpanded to consist of the T2-T11 vertebral segments, and thus, thedisplayed local graphical spinal column representation 42″ is expandedto consist of the T2-T11 vertebral segments (including the entirety ofall of the graphical lead representations 12). In the case illustratedin FIG. 10, the portion of the global graphical spinal columnrepresentation 42′ over which the view finder 104 is displayed iscontracted to consist of the T9-T11 vertebral segments, and thus, thedisplayed local graphical spinal column representation 42″ is contractedto consist of the T9-T11 vertebral segments (including only thegraphical lead representation 12 c).

In alternative embodiments, the borders of the view finder 104,themselves, can be used as control elements that can be dragged tocorrespondingly expand or contract the view finder 104. In this case,the borders of the view finder 104 cannot be used to displace the viewfinder 104 in the manner discussed above with respect to FIGS. 7 and 8.Instead, the pointing device may be placed adjacent the interior of theview finder 104 to displace it.

Once the lead configuration is established in the lead configurationscreen 100, a different display screen can be accessed to program theneurostimulation leads 12 with the desired stimulation parameters, e.g.,in the manner described in U.S. patent application Ser. No. 12/501,282,which has been previously incorporated herein by reference.

Although the foregoing technique has been described as being implementedin the CP 18, it should be noted that this technique may bealternatively or additionally implemented in the RC 16. Furthermore,although particular embodiments of the present inventions have beenshown and described, it will be understood that it is not intended tolimit the present inventions to the preferred embodiments, and it willbe obvious to those skilled in the art that various changes andmodifications may be made without departing from the spirit and scope ofthe present inventions. Thus, the present inventions are intended tocover alternatives, modifications, and equivalents, which may beincluded within the spirit and scope of the present inventions asdefined by the claims.

1. (canceled)
 2. A non-transitory machine-readable medium includinginstructions, which when executed by a machine, cause the machine to:receive a user-selection of a lead type; present an image on a display,wherein the image includes a representation of a spine and arepresentation of at least one lead of the selected lead type arrangedwith respect to the representation of the spine; receive, via a userinterface, a user-requested change to the image, wherein theuser-requested change corresponds to a change to the representation ofthe spine in the image; and respond to the received user-requestedchange by changing the image to include the change to the representationof the spine.
 3. The non-transitory machine-readable medium of claim 2,wherein the representation of the at least one lead includes arepresentation of staggered leads.
 4. The non-transitorymachine-readable medium of claim 2, wherein the image presented on thedisplay includes a control element configured to be moved by auser-controlled pointer device in the display, and wherein theuser-requested change to the image corresponds to movement of thecontrol element.
 5. The non-transitory machine-readable medium of claim4, wherein the control element is configured to be dragged by theuser-controlled pointer device to provide the user-requested change. 6.The non-transitory machine-readable medium of claim 5, wherein therepresentation of the spine includes a representation of at least onevertebra in the spine, and the change to the representation of the spineincludes a change in a displayed size of the at least one vertebra. 7.The non-transitory machine-readable medium of claim 5, wherein thechange in the displayed size of the least one vertebra includes a changein a vertical length of the at least one vertebra.
 8. The non-transitorymachine-readable medium of claim 5, wherein the representation of thespine includes displayed vertebral levels, and the change to therepresentation of the spine includes displaying different vertebrallevel.
 9. The non-transitory machine-readable medium of claim 2, whereinthe user-requested change to the image that corresponds to the change tothe representation of the spine in the image does not correspond to achange in the representation of the at least one lead in the image. 10.The non-transitory machine-readable medium of claim 2, wherein theuser-selection of the lead type includes a user-selection of apercutaneous lead.
 11. A method, comprising: receiving a user-selectionof a lead type; presenting an image on a display, wherein the imageincludes a representation of a spine and a representation of at leastone lead of the selected lead type arranged with respect to therepresentation of the spine; receiving, via a user interface, auser-requested change to the image, wherein the user-requested changecorresponds to a change to the representation of the spine in the image;and responding to the received user-requested change by changing theimage to include the change to the representation of the spine.
 12. Themethod of claim 11, wherein the user-selection of the lead type includesa user-selection of a percutaneous lead.
 13. The method of claim 11,wherein the user-requested change to the image that corresponds to thechange to the representation of the spine in the image does notcorrespond to a change in the representation of the at least one lead inthe image.
 14. The method of claim 11, wherein the image presented onthe display includes a control element configured to be dragged by auser-controlled pointer device in the display to provide theuser-requested change.
 15. The method of claim 14, wherein therepresentation of the spine includes a representation of at least onevertebra in the spine, and the change to the representation of the spineincludes a change in a displayed vertical length of the at least onevertebra.
 16. The method of claim 14, wherein the representation of thespine includes displayed vertebral levels, and the change to therepresentation of the spine includes displaying different vertebrallevel.
 17. The method of claim 11, wherein the representation of the atleast one lead includes a representation of staggered leads.
 18. Amethod, comprising: presenting an image on a display, wherein the imageincludes a representation of a spine and a representation of at leastone lead of the selected lead type arranged with respect to therepresentation of the spine; receiving, via a user interface, auser-requested change to the image, wherein the user-requested changecorresponds to a change to the representation of the spine in the imageand does not correspond to a change in the representation of the atleast one lead in the image; and responding to the receiveduser-requested change by changing the image to include the change to therepresentation of the spine.
 19. The method of claim 18, theuser-requested change includes a control element in the display draggedby a user-controlled pointer device.
 20. The method of claim 18, whereinthe representation of the at least one lead includes a representation ofstaggered leads.
 21. The method of claim 18, wherein the representationof the spine includes a representation of vertebrae in the spine, andthe change to the representation of the spine includes a change in adisplayed vertical length of at least one vertebra, a change in a numberof vertebrae included in the representation, or a representation of adifferent vertebral level.